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Abstract
Multislice computed tomography (CT) is emerging technology that enables imaging the moving heart with high resolution. The current technology of CT is represented by 64-slice CT. CT is becoming the first-line evaluation tool for the detection of significant coronary artery stenosis and is applied for the detection of plaque composition and functional imaging. Significant coronary artery stenosis can be detected with a high accuracy over 90% and can be reliably excluded with a high negative predictive value approaching 100% by using 64-slice CT. CT coronary angiography is recommended not only to exclude significant stenosis in patients with equivocal symptoms or intermediate results on stress test but also to assess obstructive disease in symptomatic patients. Quantification of coronary artery calcium with CT is helpful to select patients for lipid-lowering therapies, who have intermediate coronary artery disease risk. With technical improvement, spatial and temporal resolution of CT will reach the level enough to establish the diagnoses of in-stent restenosis, plaque composition, and ventricular and valvular function in the foreseeable future. Myocardial imaging including myocardial perfusion and viability may be possible without increasing radiation exposure. CT is a very promising technology for cardiac imaging because, with technical improvement, clinical benefits are expected to be greater than the risk of radiation exposure. This short review is for readers ① to understand CT technology for cardiac imaging, ② to understand the limitation of current technology of CT for cardiac imaging, ③ to learn the current application of CT in cardiac diseases, ④ to get a perspective on the future directions of cardiac CT.
Figures and Tables
Figure 1
The mid to distal left anterior descending artery is almost occluded by an eccentric noncalcified plaque (arrows), which measures 20 HU suggesting lipid-rich composition
Figure 2
The left internal thoracic artery graft (black arrows) is connected to the distal left anterior descending artery. A Y-shape connection using a radial graft from the left internal thoracic artery graft to the first obtuse marginal branch shows a focal stenosis (white arrow)
Figure 3
The proximal right coronary artery is totally occluded. CT coronary angiography excellently reveals the extent of occlusion (arrows), distal contrast-filling by collateral flow, plaque density, and vascular remodeling
Figure 4
A stent in the proximal left anterior descending artery shows patent lumen without evidence of restenosis by using 64-slice CT
Figure 5
The 10-minute delayed CT scan after contrast administration (left panel) shows high enhancement of the septum, apex and lateral wall (white arrows). A dark poorly enhanced band-like region is noted sub-endocardially at the apex, which is considered as microvascular occlusion. The magnetic resonance image (right panel) obtained by delayed enhancement protocol shows transmural hyperenhancement at the same area as CT shows
References
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